Provider Demographics
NPI:1821334517
Name:POWELL, KIM (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:KIM
Middle Name:
Last Name:POWELL
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3601 4TH ST STOP 7465
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79430-7465
Mailing Address - Country:US
Mailing Address - Phone:806-743-3270
Mailing Address - Fax:806-743-3260
Practice Address - Street 1:3601 4TH ST STOP 7465
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79430-7465
Practice Address - Country:US
Practice Address - Phone:806-743-3270
Practice Address - Fax:806-743-3260
Is Sole Proprietor?:No
Enumeration Date:2012-12-27
Last Update Date:2012-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX25929183500000X, 1835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
No183500000XPharmacy Service ProvidersPharmacist